HF4902

Purpose

• The bill aims to modernize how aging and disability services are delivered and funded in Minnesota. It focuses on updating how nursing facility care is assessed and paid, aligning state rules with the federal Medicaid program, and updating various related statutes and administrative processes. It also broadens requirements for licensing, program integrity, background checks, and program reporting.

Main Provisions

• Reforms nursing facility payment and assessment systems:

  • Introduces the Patient Driven Payment Model (PDPM) as the main case-mix reimbursement method for nursing facility payments under Medicaid, based on a resident’s condition, diagnoses, and the care provided during the MDS assessment.
  • Maintains the current case-mix method (RUG) for residents with an assessment reference date (ARD) before a specified date, transitioning to PDPM for ARDs on or after October 1, 2025.
  • Defines key terms used in the PDPM framework (see Definitions section), including MDS, ARD, case mix index, and index maximization.
  • Sets the transition timeline so that PDPM-based payments begin for new assessments with ARD on/after October 1, 2025, with a separate provision preserving the existing RUG system for earlier ARDs.
  • Establishes the Nursing Facility Level of Care determination as the process used to determine a resident’s need for nursing facility-level care for Medicaid long-term care payments, aligned with the scheduling in the PDPM framework. This determination is effective January 1, 2027 or upon federal approval, whichever is later.
  • Expands the scope of eligible services and waivers related to nursing facility care (e.g., brain injury and community access for disability and inclusion waivers) within the PDPM framework.

• Updates key terminology and definitions used in long-term care:

  • Adds and clarifies definitions for ARD, MDS, ADL (activities of daily living), nursing facility level of care, case mix index, and PDPM.
  • Clarifies who may act as a “Representative” for residents in the context of nursing facility decisions and payments.

• Aligns multiple statutes and administrative provisions:

  • Proposes conforming changes and amendments to a broad set of Minnesota Statutes chapters related to aging and disability services, licensure, program integrity, background studies, forecasting, and appropriations.
  • Repeals or updates numerous existing statute sections to align with the PDPM-based approach and other modernization efforts.
  • Requires reporting and forecasting related to program appropriations as part of the modernization.

• Implementation and oversight:

  • Requires new data definitions and standards to be used in the assessment process (MDS) and in determining the appropriate payment classifications.
  • Sets timelines for implementation and federal readiness, including the coordination with state and federal approval processes.

Significant Changes to Existing Law

• shifts to a PDPM-based nursing facility payment model for Medicaid long-term care services, replacing the prior case-mix system (RUG) for new assessments after October 1, 2025 (while preserving RUG for earlier assessments).
• updates the Nursing Facility Level of Care determination to determine eligibility and payment for long-term care services under Medicaid, with a targeted effective date in 2027 or upon federal approval.
• adds and restructures key definitions (ARD, MDS, ADL, case mix index, PDPM) to support the PDPM framework and unified payment methodology.
• expands and updates the scope of services and waivers included in the PDPM and nursing facility payment structure (including brain injury and community inclusion waivers).
• repeals or repeals-and-replaces multiple statutory sections across aging and disability services, licensing, and program integrity to implement the PDPM framework and related reforms.
• increases reporting obligations and forecast adjustments to reflect budgeting and program needs under the new system.

Definitions (Key Terms from the Bill)

• ARD (Assessment Reference Date): The end point for lookback periods in the MDS assessment process.
• MDS (Minimum Data Set): The standard set of assessments used to determine care needs and payment classifications.
• ADL (Activities of Daily Living): Includes bathing, dressing, eating, transferring, mobility, etc.
• Case Mix Index: A weighting used to classify residents for reimbursement.
• PDPM (Patient Driven Payment Model): The new payment classification system based on resident condition, diagnoses, and care provided.
• RUG (Resource Utilization Group): The prior case-mix classification system used before the PDPM transition.
• Nursing Facility Level of Care: The determination used for Medicaid payment of long-term care services under specified programs.

Relevant Terms - Minnesota Statutes, Medicaid/MA payments, nursing facility, aging and disability services - MDS, ARD, ADL - PDPM, RUG, case mix index - Nursing facility level of care determination - Brain Injury waiver, Community Access for Disability and Inclusion waiver - Elderly waiver, CADI/BI waivers - Licensing, program integrity, background studies - Lookback period, assessment, reimbursement classifications - Forecasted program appropriations, reporting requirements

Note: The summary focuses on the substantive aims, main changes, and key terms present in the provided bill text, with emphasis on how nursing facility assessments and payments are planned to shift to a PDPM-based system and related statutory updates.